![]() Some TCAs are more activating and have been used to treat a subset of depressed patients who experience hypersomnolence and daytime lethargy. 4 Doxepin is now marketed in the US as Silenor, in 3- and 6-mg dose strengths for primary insomnia.Īntidepressants and their effects on sleep physiology The studies demonstrate the efficacy of low-dosage doxepin therapy (3 and 6 mg qhs) for alleviating symptoms of insomnia. 3 Doxepin has been studied at very low dosages in patients with primary insomnia. Pharmacologically, the TCAs noted for their sleep-enhancing effects are more potent in blocking the serotonin transporter than the norepinephrine transporter, in addition to exerting prominent blockade of histamine H 1 receptors. In recent years, clinicians have scaled down the dosages of these antidepressants to well below established ranges to treat insomnia symptoms. TCAs such as amitriptyline and doxepin are used in depressed patients who have prominent insomnia. Pharmacological differences among TCAs translate into clinically differentiating features. 2 A number of antidepressants affect other neurotransmitter receptors, such as muscarinic ACh, α 1-adrenergic, and histamine H 1receptors, that are implicated in sleep regulation. 1 In particular, norepinephrine and serotonin play prominent roles in suppressing REM sleep, while acetylcholine (ACh) plays a key role in the initiation of REM sleep. It is thought that all approved antidepressants work through modulation of monoamine neurotransmitters, including norepinephrine, dopamine, and serotonin, all of which have been shown to exert prominent effects in regulating sleep-wakefulness and sleep architecture ( Table). The antidepressants are a prototypical example of the potentially complex interactions between psychiatric medications and sleep. In addition to resolving sleep-related symptoms through their primary therapeutic effects, many psychiatric medications have secondary effects on sleep that can contribute to their overall therapeutic benefit or sometimes counter them through adverse effects. Many psychiatric disorders are accompanied by disturbance of sleep.
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